Grant: Operating Grant

Injection heroin users are at extremely high risk of many drug related harms including HIV, hepatitis C and overdose death. Some are unable to stop injecting, despite the associated harms to themselves and the community. Considering the severity of the harms associated with long-term injection, it is very important that the health care system reaches this vulnerable population. While some treatments exist, they are not always successful, especially for people with the most severe cases of addiction. As a result, these people do not receive treatment and remain outside of the health care system. Studies in Europe and Canada have shown that medical-heroin can effectively attract, retain and improve the health of this vulnerable population. Unfortunately, medical-heroin poses regulatory and logistical challenges in Canada and worldwide, creating an important need for alternative medications that are as effective. A Canadian trial is testing if a licensed pain medication is as good as medical-heroin and preliminary results confirm this, suggesting it could be a licensed alternative. Patients in that trial were not told what drug they were receiving. When people do not know what drug they are receiving we can 'trust' their responses are due to the 'true' effect of the drug (and not their opinions). However, in the real world, patients will know what treatment they are receiving, and that can influence their treatment decisions. This study will investigate if this licensed pain medication works in real-world conditions. Our patients are the only patients in the world to receive this medication for heroin dependence. Our results will provide evidence to potentially benefit hundreds of thousands of people with heroin addiction living in countries where this treatment would be accepted and medical-heroin will not. As these treatments expand from Vancouver to other settings and systems, this evidence can be used to ensure that patients have the best chances of success.